Doctoring & Healthcare

All Articles in the Category ‘Doctoring & Healthcare’

Balance And Bad Parenting, Maybe

3-27 jumpingLast night four Swansons sat in row 6 of a little commuter airplane on the way to visit family, all plugged in. Four people who love each other with four separate devices hardly communicating for the two hours or so that we sped through the air. At first glance it can look like an utter failure — you can hear the criticism ringing in your ears — this family must not be connected, or these working parents, pounding out emails and prepping presentations while their children watch videos and play apps, really must have their priorities off, right? Right.

Maybe.

On that flight I read a beautiful blog post from tenacious pediatric researcher Dr Jenny Radesky that questions the new world in which children are being reared. The one where their parents are plugged-in, distracted, perhaps less attentive and less available while raising infants and young toddlers. It’s the same world today, where preteen digital natives may be connecting more by text than by talking. She cites data that found, “if you take away preteens’ mobile devices and make them hang out with their peers in the country for one week, they get better at reading other people’s facial expressions.” Perhaps these children and teens are swapping thumb skills for interpersonal ones. Radesky is the researcher behind the observations out last year evaluating parents’ use of mobile phones at dinner that alarmingly demonstrated children’s near need to act out to get their parents’ attention.  Are our parent-child connections forever changed because of the profound brilliance that digital devices have in capturing our attention? Radesky brings up the zone of proximal development (I’d not previously heard of it) and its profound value. She says,

In order to effectively teach children how to regulate their behavior, we need to interact with them in what psychologist Lev Vygotsky termed the child’s “Zone of Proximal Development (ZPD).”  This means  knowing their cognitive and emotional sweet spots: what they can do on their own, what they can’t do, and what they can do and learn with an adult’s help.  You can’t fit the puzzle pieces in yet?  Let me guide your hand a little bit until you figure it out by yourself. You can’t calm down when you’re frustrated yet. Let me help you identify what emotion you’re feeling and then show you some options for calming your body down. And I’ll slowly take my support away until you can do this skill on your own.

Oh yes, we certainly do need to be in this space and be available, eyes connected, body engaged, actively listening to the loves of our life (children). In championing this reality we can easily finger-wag that how things used to be (without smart phones and wild virtual connection to data and community) is better. Slow down, unplug, unwind, and CHECK BACK IN, right? Common Sense Media even has a new PSA campaign, that I happen to love, tagged #realtime guiding us back to life with a series of delicious, tight videos reminding us how we mess up. Read full post »

E-Cigs And A Free App To Help Quit Smoking

Last week a proposal was introduced that would give Washington State the toughest e-cigarette laws in the country. If passed, House Bill 1645 would significantly raise the taxes on e-cigarettes, ban the sale of flavored vaping liquids, ban online sales to Washington residents and require producers to list ingredients on labels. And while opponents of the bill argue that e-cigarettes are “healthier” than tobacco, there’s no denying the dangers of having such a highly addictive substance in arm’s reach to children and teens in an unregulated manner. Washington isn’t the only state taking action. This week California released a campaign calling out marketers of e-cigs for targeting teens. Teens are using e-cigs more and more with 1 in 5 high school sophomores here reporting having used them in the last month. E-cigarettes and e-hookahs may carry an illusion of safety they don’t warrant.

What House Bill 1645 Proposes

  • Instill a 95% tax on vaping products similar to tobacco product taxes
    • Right now only North Carolina and Minnesota have imposed taxes on E-cigarettes
  • Make it illegal to sell flavored liquid nicotine or other vaping fluids
  • Ban internet sales to Washington residents
  • Require ingredients list on all labels

Curbing An Urge To Smoke: An App For That

Supporters of e-cigarettes and those fighting against regulation often claim the devices are helpful in helping tobacco users quit, so-called harm reduction. I certainly won’t and can’t argue with anecdotes that this is useful for those wanting to quit. While this concept hasn’t been entirely disproved or entirely proven, there is still a lot we don’t know about vaping and the effects of liquid nicotine. If you or someone you know wants to quit tobacco, there are some new digital resources available to help you kick the habit. The good news is we can be hopeful that dual-pronged approaches may help those wanting to quit earnestly succeed. Download this app?

3-23 smartquit

Image courtesy: Washington Department of Health

Washington State residents have access, for a limited time, to a free app called SmartQuit. Sponsored by the Department of Health, the app is a tobacco cessation program that proved three times more effective than trying to quit on your own, according to a recent study from Fred Hutchinson Cancer Research Center. SmartQuit users create a personal plan to become aware of their urges to smoke, they then learn new ways of thinking about those urges to suppress the desire to smoke. The Washington Department of Health is offering the app for free to a limited number of users. Because the funding is limited, please don’t download unless you’re serious about using the app as the number of free downloads will run out. Consider it? If you or someone you know does, report back on your opinions?

Read full post »

Peanuts During Infancy To Prevent Food Allergy

Photo from Edwart Visser Flickr Creative CommonsThere’s new data out to support stronger recommendations for introducing peanuts during infancy. Like hemlines, it may seem like this data keeps changing. As time, the science and our understanding of risk unfolds we’ve seen shifts in advice about starting solids that have left many parents wondering what really is best when starting foods and wanting to decrease risk for food allergy.

Briefly, and in general, it’s best to start a variety of foods for your child during infancy, starting around 4 to 6 months of age. In fact its now believed that it may be protective to introduce things like wheat, egg, soy, fish, and peanuts even before a child takes their first step around a year of age. The 2013 recommendations (that exclude information about peanuts) are explained in this post, “When Should I start Baby Food?”

The recommendation to share diverse foods during infancy that includes fish and eggs may feel new to you. For example, when my babies were born (mid-2000’s) advice and consensus suggested that avoidance of peanuts until after a year of age was best — the thought that avoidance of peanut during critical development may be protective against severe allergy development. Now, concomitant with a doubling in food allergies, we face an utter and potentially embarrassing reality — perhaps medical advice and our work to improve allergy risk by restricting foods in  infancy did just the opposite. Perhaps avoidance was exactly the wrong thing to do. Maybe we’ve engineered part of the problem.

This kind of advice can feel intense when raising children. “Do this, don’t do that, do this now, don’t do this now!” Doing the right thing is what we all want but doing right can remain elusive, especially when recommendations shift. I remember a fellow pediatrician questioning my eating a peanut butter sandwich while I was pregnant with my second son. She couldn’t believe I’d made that choice. At the time I remember not only feeling judged but a little terrified too. Perhaps I’d not take the data seriously enough? Oh goodness, I thought, as I diligently didn’t introduce “high allergy” foods until toddlerhood for my boys. Today I realize that wasn’t all that right either. It can feel like another hemline change for sure and yikes these sure are shorter skirts!

Fast forward 7 years to 2015. A New England Journal of Medicine study out this past month systematically evaluated risk for development of peanut allergy in children who were at higher risk for developing the allergy in the first place. And they started with infancy and introduced peanuts early in some of the babies. Researchers found if infants were introduced to peanuts early in life (between 4 and 11 months of age) their risk of peanut allergy at age 5 years significantly decreased.

The early introduction of peanuts significantly decreased the frequency of the development of peanut allergy among children at high risk for this allergy.  ~ New England Journal Of Medicine

Read full post »

Vaccines, Profanity, And Professionalism

Screenshot 2015-02-01 12.30.40You’ve likely seen the Jimmy Kimmel “public service announcement” on vaccines. Over 3 1/2 million people have viewed it on Youtube so if you’re not yet one of them you’ll likely add to the tally now. The first 3 minutes of the monologue are spot-on and they’re also very funny. Jimmy takes a stand against the “anti-vaxxers.” He mentions that some parents are more scared of “gluten than small pox” and references the reality that some schools in this country have 20% of students opted out of some vaccines. His monologue is followed by a series of pediatricians voicing profane frustration. Most people think the video is hilarious and many of us fired up about vaccines feel a rush when the safety and trust we have in vaccines gets the spotlight like it does here. Jimmy’s script is brilliantly written and his execution is direct.

Thing is, I didn’t like the video. I was left feeling somewhat uncomfortable and embarrassed for my profession. Immediately I wanted to explain that even though many of us are frustrated with where we are on vaccine hesitancy, we really aren’t interested in offending. We will always work to partner with parents –we won’t mock, swear, or intimidate you. Our goal is to support, protect, and cure children whenever we can and our privileged responsibility is to listen to parental fear and connect families with resources that soothe. This really is why we went to medical school.

It’s exciting when celebrities voice-up and stand to talk about vaccine issues that reflect science. It’s especially exciting when they include practicing physicians. Counseling families who are hesitant or flat-out refuse vaccines is a part of the job for every pediatrician. A study published in the journal Pediatrics this week found 93% of pediatricians had reported they’d been asked by parents to skip or delay vaccines in the last month. The current measles outbreak has changed the tone of these conversations for many of us; I’ve written about my new stance because I’m enraged pockets of measles can even occur in 2015. That being said, even though I really do like to swear like these pediatricians when I’m out of public earshot, I’m unsure the tactic of this PSA will do any good for those parents who hesitate to immunize their children according to the tested and safe schedule.

It seems to me that if parenting is governed by love, pediatrics is governed by respect for that love and for the integrity of children individually.

Read full post »

Cocooning For Measles

2-12 measles cocooningThe measles outbreak continues to spread, with 121 cases now reported in 17 states (CDC data as of February 6th). Many states are getting serious about detailing why exemptions for vaccines exist and looking at ways to better protect the population. This week in the Seattle Times three local pediatricians speak out for removing both personal choice and religious exemptions to protect the public and vulnerable children. And here, Dr Paul Offit writes about religious exemptions asking, “What Would Jesus Do About Measles.”

There’s no question vaccines are having their moment. We are working through tough questions. In the Seattle Times piece, Drs. Diekema, Opel, and Marcuse keenly point out:

We hold dear both freedom of choice and public health.

Finding an optimal balance is clearly of great import. This will take great advocacy and work to help continue to build trust in the MMR vaccine that is safe and highly effective at preventing measles infections.

Though I’ve been lucky enough to avoid seeing measles thus far in my medical education and career, this serious, uber-contagious disease has given some parents and caregivers pause when it comes to putting their unprotected (read: too young to vaccinate) infants in a situation where their health could be compromised. Many mothers have emailed, tweeted and Facebook messaged me asking how they can protect their little ones who haven’t received their vaccinations yet and my simple answer is this: cocooning. That is, provide a family of protection by having every single child & adult immunized against whooping cough, influenza, and other vaccine preventable illnesses. By surrounding a baby with only immunized people, you cocoon them against serious infections. Read full post »

Measles Outbreak With A Baby At Home

baby-O-e13075541951481Many parents around the U.S. are asking what to do about a possible measles exposure with a baby at home who is too young to be immunized. Should they stay home? Can they travel? Should they cancel that trip to Utah or to Vermont or even to Disney next month? Can they head out to the store without worry? Are they “safe?”

I hate that I can’t completely say they are safe. Measles is wildly contagious and during an outbreak it can spread, especially to older infants who aren’t vaccinated yet. The good news is that risk is low (more than 90% of us won’t get measles because we’re vaccinated so we also won’t spread it to you!). Some parents are also wondering about getting the vaccine before the baby turns 1 year because they’ve heard the recommendation for infants traveling abroad: infants traveling outside the U.S. are recommended to get an MMR (measles, mumps, rubella) shot if they are over 6 months of age (of note, babies who get the shot as an infant also get the usual shot again at 12 months of age). Without travel plans we wait to immunize babies with their first MMR vaccine until they are 12 months of age. Over 95% of babies who get the shot at 12 months of age are protected against measles and over 99% are protected for a lifetime after the 2nd dose (given at least 1 month later). Wow, right?

“This is not going to be the end-all-be-all post on protecting your infant or child from measles'” Dr Matthew Kronman, a pediatric infectious disease expert at Seattle Children’s, reminded me as we chatted today. Advice and guidance for protecting babies and children will change as we learn again how to protect our population from measles infection while unvaccinated pockets of people remain.

The CDC warns that the outbreak could grow (there’s over 100 cases in 14 states as of today) and nationally there’s a palpable dialogue going on between the herd (those immunized) and those not. Politicians are involved — Governor Christie talked today about “choice;” Obama is urging parents to immunize right along side the president of the American Academy of Pediatrics who released another urgent statement. Pediatricians, family docs, nurse practitioners and health workers everywhere are encouraging parents to get shots up-to-date to protect their own children and vulnerable populations (this includes infants).  Here’s a bit of evidence and information that can hopefully curb anxiety for parents to babies. I teamed up with Dr Edgar Marcuse, a lifelong scholar with vaccines, former pediatrician at Seattle Children’s and an emeritus professor of pediatrics at University of Washington and Dr Matthew Kronman. Here are 7 tips about infants and families that may help shape your thinking: Read full post »

Enraged By 2015 Measles In America

Screenshot 2015-02-01 12.30.40I wept at the end of the movie I watched last night, The Imitation Game. The reason really was this: it reminded me how we’re just so terrible to each other at times. How much suffering occurs when we don’t think things through. The movie wasn’t about measles or vaccination, but injustices in it pushed me to leave my Sunday morning with my children to share this:

My patience with vaccine hesitancy has pivoted. I’m embarrassed to say it took an outbreak of measles stemming at Disney to move me from impatient and passionate to hands-on-my-hips fired-up and disappointed. Today I feel a bit of outrage that unvaccinated families are not pounding on the door to get their MMR vaccine, even on Superbowl Sunday. In my mind they should be doing so selfishly (for personal protection) and they should be doing so altruistically (for others who really count on them). I expect both from the public.

Read Charlie and the Chocolate Factory author Roald Dahl’s 1988 message about his daughter’s death from measles — insane that it rings true today.

I feel somewhat enraged that many parents with babies in the United States are nervous right now about their infants getting measles. The chance is small but it shouldn’t even be a chance when there is a vaccine that is nearly 100% protective for those milling around these delicious babies. I’m angry because a friend of mine has a child who got measles when she was too young to be immunized. I’m enraged that children who fulfill their “Make A Wish” trip to Disneyland — after a liver transplant or after chemotherapy or after a tumor is cut out of their bone — must feel a little shaky making the choice to go there now. Can you imagine getting a short straw like a liver that didn’t work like it should or a childhood cancer diagnosis and then getting another one (increased measles risk) just when you’re elevated to celebrate your life? Read full post »

Wellness Visits: A Magical Place To Communicate

As 2015 gets earnestly underway, many of us are working to keep resolutions we made to better ourselves and our family as the new year continues to unfold. In case health is a part of your resolution or focus, here are a couple very quick reminders for check-ups and interactions at the doctor’s or practitioner’s office (3 tips below). I’m going to sound very much like a pediatrician here: wellness visits and check-ups add great value to preventing things. So much better than having to do the hard work of reversing problematic changes. This isn’t just about vitamins (which children don’t really need) and shots (which children wildly benefit from). This is about communication.

Well-Child Visits And Check-ups

1-28 CDC BMI chart

Courtesy of CDC

Wellness visits often get forgotten when things are going well (hurrah!) yet they serve a grand purpose on tracking health and wellness by working to create prompts and services that prevent illness. The numbers (from vision, hearing, height, weight, body mass index, and vital signs –blood pressure, temperature, respirations and pulse) help track trends and provide alerts. They help reduce bias in our thinking as parents and pediatricians. As parents we can have a tendency to both unintentionally ignore warning signs of health risks or over-analyze perfectly normal developmental phases. Case in point: half of parents of overweight/obese children underestimate their child’s weight. On the other end of the spectrum, 1 in 7 parents believe their normal-weight child is too skinny. As a reminder, reading a growth grid has a lot less to do with numbers than it does trends. The import lies in following lines; is your child tracking, are they growing at the right rate, do they deviate or “fall-off” the curve? Here’s a quick video where I explain how to interpret the growth grid if you want to learn more.

Importantly, these visits also facilitate a place to bring up the questions that nag at you. Often those things are about habits, sleep, anxiety, body size/shape, school work or mood — or just how a child sees the world. Use the prevention visit to squelch anxiety of your own. What parent doesn’t have something pulling on their sleeve of worry while raising another human? The task of parenting is always somewhat monumental and the job description is always shifting as our children grow. The stakes are high when a child’s life is guided by another. Read full post »

Winter Skin And Itches That Rash

OTC-Dry-Skin-Infographic_FinalLiving in the northwest it’s easy to forget the sun exists during the winter. Most days are dim, usually drizzly and almost always cloud-covered. It’s easy to remember to take care of your skin when your arms and legs are playing in the warm rays of the sun but when you’re bundled under scarves and rainwear, our self-care falters. We care for our children’s skin often better than our own. Winter brings a slew of skin harms with it. Giving your skin the TLC it needs during these dark months will keep it healthy (and looking great) once it’s time again for spring exposure.

Dry Skin And “The Itch That Rashes”

Our skin gets dry in the winter for a variety of reasons. Cold temperatures, lack of humidity and recirculated air (hello office heater!) can all contribute to dry, scaly spots. Winter is also a time when we see an increased risk for eczema flare-ups, a chronic, relapsing condition that brings incredibly dry, itchy patches of skin. The icing on the cake is that eczema primarily affects kids! A recent study suggests at least 10% of children in the US suffer from eczema, the “rash that itches.” A patch gets started, a child can’t help but itch it and the rash blooms. Between 2000 & 2010 pediatric cases of eczema came close to doubling and while this condition not only affects how skin looks and feels, it can have a direct impact on a child’s quality of life. Nearly half of kids with eczema report a severely negative impact on their quality of life, including sleep deprivation (from the itching), activity restriction and even depression. If your child suffers from eczema, talk to your pediatrician to create an action plan for combating these dry months and hopefully avoiding such severe tolls and trolls on everyday life.

Protecting Your Skin Year Round

Read full post »

Power Of A Kiss And Family Oral Health

Image courtesy: American Dental Association

Image courtesy: American Dental Association

Oral health doesn’t start and end with the dentist. Times are changing as the Washington Dental Service Foundation has trained 1,600 pediatricians and family physicians throughout the state on the importance of oral hygiene in young children. Pediatricians are now applying fluoride during well-child check-ups and counseling families more comprehensively on how to prevent dental decay while also referring to dentists for prevention and acute dental problems. Just last month I attended the 1-1/2 hour oral health training with a pediatric dentist. That learning coupled with a new policy statement from The American Academy of Pediatrics highlighting the importance of oral health inspired me to get the word out. I suspect we can all do a bit better protecting our children’s mouths. Recommendations for fluoridated toothpaste have recently changed (use it with the very first baby tooth!) as has knowledge and reminders about how we share our bacteria with our children. What we do for our mouth may have direct effects on our children’s.

The Most Common Chronic Childhood Disease

  • The facts about oral health in children are a little surprising. By their first birthday 8% of toddlers have cavities in their mouth and the Pediatrics policy detailed 24% 2-4 year-olds, 53% 6-8 year-olds and 56% 15 year-olds also have dental disease. Since oral health (even in babies and toddlers) is an integral part of overall health of children this is problematic. Dental disease has strong links between diabetes, respiratory infections and heart disease. The numbers for children with dental disease are high (!!) which makes dental disease the most common infection of childhood.
  • Good news is much of this disease can be prevented (or corrected) and because infants and young children see the pediatrician more frequently than the dentist, it’s becoming clear that pediatricians need to hone skills on oral health, the disease process, prevention and dentist interventions when necessary.

4 Things I Learned About Oral Health

Read full post »